welcome to the hilton...please dont forget to tip your waitress - page 7
i have no idea where the er is getting these people from but i wish theyd send them back...lol they are sick..yes...but for goodness sakes! i cant raise the head of my bed (i can however use... Read More
Jun 12, '02As I read these posts, I am reminded that one of the things I love most about urgent care is the very limited time that we spend w/ pts, but with some of them, 5 minutes is about 10 too many!
I had a 3-year-old kid with a head lac that really did need suturing. When I sat the family down in the tx room, mom was holding the kid as he happily played with Winnie the Pooh and Tigger... ZERO distress, until I attempted to take an axillary temp. Why the process of holding his arm at his side was so intolerable, I do not know. I then intended to take his pulse by holding his wrist, but he hit me in the face with Tigger. Mom did nothing. Still trying to be patient, I placed my stethoscope lightly on his back, reassuring him that this would not hurt. He immediately yanked my Littman, ripping the earpieces out of my ears. Mom said languidly, "Oh, that must've hurt" I looked her in the eye and said, "Yes, ma'am, it did hurt, and as a result we will just not know your son's heart or respiration rate today." I walked out of the room and documented it word for word. Even worse, when the PA went to suture him, he screamed and hit her, while the parents looked calmly on. She ended up closing the lac with Dermabond since the kid wouldn't hold still enough for suturing, and this was a kid who was playing happily 15 minutes before! It makes me crazy that people bring their kids to us so we can help repair self-inflicted damage, and then let the kids beat us to a pulp and leave complaining about inadequate treament!!!
I loved the lady who checked herself in as an EMTALA (state law says a licensed nurse has to triage w/in 10 mins) on a day we were short a doc, had a house full, backs against the wall. Her c/o? Varicose veins. She's right up there with my EMATALA guy with life-threatening hiccups. Every mom w/an EMTALA kid gives his temp as "103". When I check it, it is 98.7. Mom says, "Oh, I gave him a Motrin 30 minutes ago" A miracle drug! It will lower your temp 5 degrees in half an hour!!!
So far our favorite has been the "Meatball Terrorist". This 19-year-old checked in (with his mother!!) refusing to tell the receptionist why he was there. Finally he yelled at her, "I have a rash and my d*** hurts!" He had waited for about an hour (which he filled by throwing magazines, spitting on the floor, and cursing) when a lady came in with a gaping, bleeding laceration. Our policy requires that such wounds be taken back immediately, which agitated our rash guy to no end. He had at some point gotten a meatball sub from Subway, and as he threw it across the lobby, he yelled that he was sick of humanity and would be back to f*** us all up with his toxic waste truck. Immediately one of the PAs asked him to leave, and the entire waiting room applauded. Before he left he rescued a meatball from the sandwich lying in the corner and used it to write "Death to All" on our front door. The police actually said that in order to act, they needed "more key words". ?????
I want to put up a sign that says "This is an URGENT CARE. We treat medical problems that can't wait. We do not give booster shots. We do not insert Norplants. We do not refill old prescriptions from other doctors who are not available today. We do not do Pap smears or give orders for screening mammograms. We will treat your sinus infection, but if someone with chest pain/uncontrolled bleeding/active vomiting/SOB/labor pains comes in while you are waiting, we will see that person first. We offer no guarantees that since you have waited longer than 5 minutes, absolutely no one will arrive who is sicker than you. Once you are in the exam room, if you ask if, "as long as we're all here..." we perform well-child check-ups on your 4 Medicaid-covered children, you will go back out to the front desk and check them all in individually, as the law requires, and you will then wait for their turn. We are not a one-stop-Dr-shop, 'in and out and on your way!' kind of place. We are obligated to your immediate health needs only, not your work/personal/feeding/excercise schedule. For every profanity you utter about the wait, and every staff member you threaten, you will be moved back one place in line."
I have the support of all the staff, but none of the suits! I can dream anyway..... The sincere desire to help others is why we all went in to this line of work (most of us, anyway) but some patients make that danged hard to remember.
Jun 12, '02OH. P.S....... A man who checked in with "dizziness" apologized profusely for making our day busy- he had a BP of 50/18 had was dx'd with a GI bleed. A sweet old lady who was bleeding buckets from her rectum felt "just terrible about bothering" us. These pts are so incredibly polite and grateful, and I think they would really rather die than be an impostition! It's one extreme or the other.
Jun 12, '02Gotta blame the media and the hospitals for portraying nurses as service workers.....
Amen to this!!!!!!!Really pizzes me off too....
Jun 13, '02Before he left he rescued a meatball from the sandwich lying in the corner and used it to write "Death to All" on our front door. The police actually said that in order to act, they needed "more key words". ?????
Do they need a "key" murder weapon? A "key" body?
Think of all the "beautiful people" that the police get to enjoy all day! LOL!
Uhmmm...........Without a complete HX I can't be sure but could the rash have been.............STRESS RELATED?
Jun 13, '02what i really find revolting is those patients that demand an ambulance escort upon discharge/transfer and they demand one when they have a million annoying relatives to do the simple task......they damend in order to prolong their dying swan acts......makes me sick....... ....especialy when one thinks of how much money the public system is wasting on these leeches when it could have been put towards someone that really needs it........
or those precious ones that complain non stop about the food (yeah right asswipe, ive been to countries where people can die in the street from hunger..)....often they are the fattest grossest greediest patients and they send their analheaded relatives to the nurses station to demand we order another meal.....and when not one of them even dares contemplate trotting on down to the hospital cafeteria to buy their fat loved one a sandwich.... leeches leeches leeches no wonder the system is in dire straits.........
and the general opinion here of those that are able bodied to tend to their own adl's but demand assistance therefore taking us away from the ones that really need us there.......not to mention gnawing into our time management......
relatives that intrude on out of bounds areas such as staff toilets, ward kitchens to make a round a 10 coffees(leeches....), those that set up their own little coffee shops around a patients bedside and disregard all others....... ......alot of people have no idea out there do they.....or just no manners.........
on a final note how about those that demand trolley escorts when they could have a wheelchair or those that insist on o2 allthough their o2 sats are above 98% on room air??.....dont even think about the o2 cylinder i have to lug with me on top of everything else you precious puntzzzzzzzzz............
had a shift from hell guys sorrrrrrrrrrry to sound like a prized whinger!!!!! but only other nurses really understand the other dont they.......:d thats why this forum is such a fantastic outlet only wish i had more time to peruse it.........
Jun 13, '02I had a patient again last night in ICU that I took care of last week after she had surgery to repair an esophageal perforation. She had peritonitis, on the vent, a real train wreck but she seems to be pretty nice. Anyway, I had been warned that the daughter (who's in, just finished her FIRST semester) is full of questions, like 1) "Why are the QRS segments different now than they were when I visited at 5?" (because I changed EKG leads to v1 instead of lead II) 2) "Why is the vent alarming?" (because your mom just coughed) etc. But I did not expect this one from the husband: "Is there an order written in my wife's chart that you can't give her pain medicine unless she asks for it?" What?!? What the h@!! are you talking about? (OK, so I said, what do you mean?) "The day nurse said she couldn't give my wife pain medicine unless she asked for it. I don't think she can with the tube down her throat, do you?" Well, I said, she just asked me for a shot about an hour and a half ago, so I guess she can ask. "Oh, well, can you give her medicine anyway even if she doesn't ask?" Yes, we can give it, but if you ever want her to come off that vent, she's going to have to be a little awake and breathing over it. We can't keep her sedated all the time when she's this close to coming off. (She was on IMV of 4 and pulling her own TVs higher than the vent was giving her). I told her I would ask her regularly and premedicate before dressing changes, etc., but I was not going to push morphine on her every two hours if she didn't need or want it. He said he understood and that was fine. "And by the way, we don't want the nurse that took care of her back tomorrow. I don't want her to ever set foot in that room again." Now, granted, the nurse in question can be pretty gruff (I thought she was a total bytch when I was in orientation, but she's kind of grown on me here lately) but she is a good nurse, and I know that she was doing what was in the patient's best interest. She even called the doc and got the MS order increased and to be given more frequently because it obviously wasn't lasting long enough. So I just told the husband OK and passed the word on to the charge nurse who was making assignments.
Night before last I had a post-op lobectomy who wanted hot tea. Now, ICU is not the best place in the hospital to find food or drink, and certainly not something as obscure (at least around here) as hot tea. But I searched and found it, made it, and brought it to her. "Oh, it's decaf? I don't want it then. I'll just wait till my daughter comes," she sighs. (BOO-HOO) Stupid me, I left it on the bedside table, thinking if she changes her mind, it's there. Half an hour later, d@mn call bell, "I spilled my tea, can you get me some more?" Sure enough, whole f-ing cup of tea in the bed AFTER I gave her a bath and changed the sheets. I changed her gown and rolled one of the draw sheets out from under her. That was all she was getting. And needless to say, NO MORE TEA! The only reason she came to the unit was because she was on Neo to keep SBP above 140 after surgery (resp. distress with lower pressures?!). I looked under the pillow and never did find my tip!
Ugh. I'm with SICU Queen! Intubated and sedated (on Diprivan preferably!) is the best patient in the world!
Can we pass out chill pills to the families?!?
Jun 13, '02Oh, yeah, had another great family last night, and it wasn't even my patient. Patient coded on tele floor last week and transferred into unit. Went for a heart cath today and rolled back in around 8PM. Visiting is at 9PM. Got her settled and it was 8:45. Extremely nice nurse lets family come in. I was sitting at the desk and watched two family members walk in. One minute later the door bell rings. Rather than buzz them in automatically, I looked on the monitor and recognized them as this lady's family. So I picked up the phone. May I help you? "Yeah, let us in." Excuse me? "Yeah, let us in." Who is your patient? "Mrs. So-n-so." Two family members just came in, you'll have to wait till they come out and then you can come in. "What?" (I repeated myself and then they walked off without saying anything.)
When someone answers me with "Let me in," guess who ain't comin' in? I mean, they don't let just anyone into the HILTON!
Jun 13, '02"Do you know the magic word?"
Or you could ask......"What is the average airspeed of an African Swallow?" (Monty Python referrence:chuckle )
Jun 13, '02Gosh, reading the ones about the ER patients reminded me of my favorite example of (attempted) Medicaid abuse. About 6 years ago I was working ER admissions (way before I became a nurse, and yet I still went through with it!) when a lady dragged her kids in to the ER in the middle of a weekday with HEAD LICE. She told the triage nurse that the two older kids had been sent home from school and could not return without being deloused. The two younger had it too, could we treat them at the same time? What?! You must be joking. So I checked in all 4 little brats, ran their cards to make sure they were current, and saw at the bottom of the printout that there was not a primary care provider listed. I asked her if she had a family doc or pedi and she said no. I told her she had to pick one, that Medicaid had changed their rules. So I broke out the book of Medicaid providers and handed it to her, and she picked one. Then I took the chart back to the ER. The doctor personally came out to the waiting room to fetch her and the chilluns, and he kindly informed her that we do not have RID in our ER. "Well, I can't afford it. Will you write me a Rx for it so Medicaid will pay for it?" He told her that he could not, but he could tell her how to delouse her children for cheap with Vaseline, a shower cap, and lots of shampoo to wash it out. Even offered to GIVE her the Vaseline out of our stock. She told him she was going to Washington Regional (our COMPETITION) and turned around and left. I itched for a week!
PLEASE, PLEASE, COME BACK AND LET US DELOUSE YOUR CHILDREN! PLEASE DON'T GO TO THE COMPETITION! I WANT THE $17 MEDICAID REIMBURSEMENT! I NEED THE MONEY!
:roll :roll :roll
Jun 13, '02Yup, tough break losing that one. It would've probably only cost a couple of hundred dollars worth of paperwork to get your 17 bucks.:chuckle
Jun 13, '02Frequently in our hospital the DOCTORS tell the family members that they can stay in the other bed. Problem is, takes up our beds, and then they expect care too. It drives me nuts--the docs don't even bother to ask if we have room or to explain to them that they are not there as patients also. Always when you go into assess--will you take my blood pressure. I have this funny bump. Can you get me a cup of coffee etc etc. Then, after they feel really at home, they think that they can just walk into the nurse's station (while we are charting) and look over your shoulder and visit. And of course, there is always the tour of the other rooms to see who all is a patient. AAARRGGG!!!!!!!
Jun 13, '02Jeeze...you been working where I been working??? Lord! I had one pt's wife walk out in her robe, and stood there are we were busy as all heck. She stood there until the charge acknowledged her presence...and said...Can I get some coffee or do I have to throw a fit...and raise HELL!!!!!
I also most let my mouth get my butt in trouble on that one!!! GRRR!!
And the family member who tries to get next to you by making conversation about how busy you are...while you're getting your meds from the med cart!!! OOOHHHHH GRRRR!! And keeps trying to get you to stop and say something to her!!!! NOT!!
When I catch people in the beds...I tell them to get off them..as they're causing housekeeping to come back and CLEAN that bed AGAIN!!! God knows what these people have...Lord have mercy..Pleezee...on me...because there are times...I don't say a thing until I have sufficently bite my lip into...because I know I would be in BIGGGG Trouble if I didn't! OOhhhh I finally say something..but it is a FAR cry from what I would have said!:chuckle Lord give me strenght..: